By Birgit Lorenz, Francois-Xavier Borruat
The extensive box of neuro-ophthalmology encompasses lesions of either the afferent and efferent pathways, which may consequence from numerous etiologies: tumoral, paraneoplastic, vascular, inflammatory, infectious, or hereditary, simply to identify a few.
This quantity of necessities in Ophthalmology is devoted to the evaluate of recent advancements in neuro-ophthalmology, together with these in prognosis, body structure, investigations or healing strategies. it really is divided into six components, designed to supply the clinician with a precis of a few of the latest facts relating to: ailments of the optic nerve, strange retinopathies, new equipment of investigations of the retina, optic nerve, and visible mind, neuro-ophthalmic implications of a few systemic problems, oculomotility, visible rehabilitation.
This updated, concise, and functional booklet may help the clinician comprehend the weird illnesses of yes sufferers with neuro-ophthalmic disorders.
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Extra resources for Pediatric ophthalmology, neuro-ophthalmology, genetics with 26 tables
5. Fluorescein angiography in arteritic AION. 9 s in NAION. 3 Differential Diagnosis The acute onset of severe visual loss in the setting of headache and optic disc edema, particularly when bilateral, requires consideration of alternative diagnoses, including acute optic neuropathy secondary to chronic papilledema (with or without intracranial mass), infiltrative optic neuropathy, and meningeal carcinomatosis involving the optic nerves. In cases of suspected AAION with negative workup or atypical course, neuroimaging should be performed to evaluate for intracranial mass or visible meningeal thickening and enhancement, and lumbar puncture should be considered to assess for evidence of elevated intracranial pressure or malignant cells.
Based on the studies done in adults, it would seem reasonable to offer IV steroids in cases with severe visual loss (especially when bilateral), and to consider immunomodulatory agents when the brain MRI is abnormal . ■ Summary for the Clinician ■ Evidence from recent randomized, pla- cebo-controlled trials supports early intervention with immunomodulatory agents in high-risk patients with clinically isolated syndromes to decrease the risk of subsequent development of MS [4, 28]. The decision to treat high-risk optic neuritis patients with immunomodulatory agents should be individualized.
Arteritic AION is usually associated with a markedly elevated erythrocyte sedimentation rate and C-reactive protein; these studies should always be performed if there is suspicion of giant cell arteritis (GCA). Temporal artery biopsy should be performed if there is suspicion of GCA; the false-negative rate for biopsy is in the range of 3%–5%. High-dose systemic corticosteroids should be administered immediately if GCA is suspected; biopsy may be delayed 7–10 days after institution of therapy. ■ ■ ■ ■ 2 is to prevent fellow eye involvement, which occurs in up to 95% if untreated.